Close Low Cost Clinics?

[DVMDream]

Saw this article:

http://www.al.com/opinion/index.ssf/2015/02/veterinarians_zeal_to_close_lo.html

Thoughts?

---

Members don't see this ad.

 

[Jess Monster]

Upon reading, my first question was, "who the hell are all of these veterinarians clamoring for the closure of non-profit, low-cost clinics?" I read through it pretty fast but I didn't see a reference to any specific story or vet lobby group that is putting a target on these services, so if you could provide a follow up link about whatever story this person is responding to that might be helpful to discussion.

Overall, I can't imagine it would be a popular opinion among veterinarians. Still, I know that in any group there are a few kooks with opinions that fall at the extreme margins - like young-earth biologists or anti-vaxxer pediatricians. Personally, I think it would be terrible to take legal actions to prohibit these non-profit services from operating in any city/state/etc. From the low-cost rabies vaccination clinics I've helped with, it seemed pretty obvious that had it not been for that low-cost or free alternative, many people would not have sought out vaccinations from for-profit clinics anyway.

 

[Trilt]

Very few people mind low-cost rabies vaccine clinics - those serve a distinct public health advantage. The issue arises when there are full-service clinics being operated by non-profits in the area, and they don't have any income requirements to use their services. I've not met a vet yet who doesn't think providing sliding scale care to people is a bad thing, besides perhaps questioning whether that person should have pets. What absolutely grinds gears is when people who can afford to use your normal veterinary clinics uses ones that are non-profit and meant for low-income owners, and that's why people really push for income requirements to verify need.

Many vets are business owners. These feelings are absolutely not the same as anti-vaxxers or young earth biologists, and they're much more common.

 

[dyachei]

Recently one of the low cost places around my clinic went for profit but is trying to remain very low cost. I do have a problem with them. A non profit that employs vets and pays them as best they can? Great. Usually they look at income. This sort of practice is just there to make a quick buck. They still don't do a full exam to vaccinate. The quality of med is less at this particular spot. So yeah. While I usually don't mind having a cheaper alternative, I do want it to be income based. They can charge less for their vaccines when they have non profit status because they get their supplies discounted. I can't compete with that even explaining the difference.

 

[Minnerbelle]

And nonprofits can utilize volunteers and get free labor, get tax deductible donations, and get tax breaks that for profit businesses don't. If they're essentially running the same exact services (or perceived as same exact services regardless of actual quality) as the for profit hospital next door and allows anyone to come in regardless of income... then it becomes unfair competition.

Again, nothing wrong with subsidized care for those who truly can't afford care at regular prices. But when the soccer mom in her Mercedes SUV takes her weimeraners to these nonprofit low cost clinics for routine care, and only utilizes for profit clinics for sick visits, it not only worsens the care for these dogs without having continuity of care, but makes prices overall more expensive for all other life saving procedures/medications. The loss of income with wellness stuff/pharmacy stuff has to be made up somewhere, and it's a huge bummer. People don't think about that and then b**** about why it's so expensive to get x-rays for a vomiting pet.

 

[deleted480308]

Nonprofit doesn't and shouldn't mean only for poor people. There is no reason to close a clinic just because you don't think it's customers are too poor to afford your rates

 

[CalliopeDVM]

I know of lots of vets who want to limit non-profit and charitable vet clinics to those who can show a need for charitable care - i.e. fulfilling the promises made to those who donate and the reason that those clinics get tax breaks. In essence, tax dollars are going to those charitable clinics (in the form of a tax free status), and there's should be a real need before those tax dollars are awarded. I agree with them. I think charitable institutions should be limited to dealing with those who have proven need.....and virtually all "non-profit" clinics have a charitable designation with the government.

I don't know any vet who wants to limit (or shut down) low cost clinics - businesses who've chosen to lower their costs of goods and services so as to market to a particular segment of society who either doesn't want to or can't pay more. That's like the local neighbourhood diner who's chosen to sell their coffee cheap or offer "blue plate specials" for $5. I agree - there's no reason that those businesses should not be allowed to operate as they wish.

 

[Trilt]

My favourite is seeing low cost clinics' job listings for DVMs where they go on and on about high salary. It sits very poorly with me for someone to have a website dedicated to how you do things low-priced because you're compassionate and care about animals, then on the back end point out how low cost, high volume care can really make a crap ton of money.

Other low cost clinics are very straightforward about their business model and I really appreciate that. It's not the level of care I necessarily want to be providing as a DVM, or what I want for my pets (I'm looking at you, recent $1.4k+ ferret surgery...), but I recognize that as a profession we need to have some level of "tiering" to our pricing and medical care or we will definitely exclude a lot of pets from getting any care at all.

 

[pinkpuppy9]

On one hand, I completely understand wanting to get rid of competition that is doing vaccines at rates you just can't match. On the other hand, I can't see it being a good idea to continue with the effort to shut these places down. My two cents:
1. Based off of the sentiments of veterinarians I have worked with, they don't necessarily want to provide services to those who come in and either a. refuse to pay over a certain amount, regardless of income b. honestly cannot afford good care (routine or emergency). While they certainly want to provide that quality care to these animals, they cringe whenever they hear "Oh, and I don't have more than $50 for this" or "Doctor, we're stopping at $100, okay?" This is how veterinary medicine becomes a charity, and how good doctors end up volunteering in their own businesses. If you don't offer freebies, you're a horrible person. These low cost clinics pull those clients with financial troubles or those who just don't want to pay, and the clients who can pay/willing to pay will remain. These clients can't go to a low cost emergency clinic, though, so they'd still have to go to the 'normal' clinic anyways. I can't see it being a HUGE loss, although I can understand when some clinics are pinching pennies that they might feel that loss a bit more.
2. I guess I can see why these places should be more regulated. I've met a few clients who went to Tractor Supply or Petsmart or even just to the local shelter for cheap vaccines, and came to us the next day asking why their dog was covered in hives. "Well, your dog had a vaccine reaction. Why didn't you call the vet that gave the injection?" "They're not there anymore, and they never told me this could happen. I called and they told me to see another vet." I'm not sure if government involvement would solve those particular issues that I've experience such as: Not warning clients about potential reactions, not giving clients proper/good instructions for meds, not emphasizing the importance of keeping your receipt potentially for the life of the dog so you can provide a history in the case of an emergency, etc. You can argue that these clinics don't necessarily serve to educate, but to me, those are basic points that the doctor/tech/assistant/whoever at these low cost clinics needs to cover. Hearing "I don't know what vaccines my dog got, we just took him to the local pet supply store and they did some stuff" occurs far too often. Clients should take charge and know these things, but a lot don't realize that they should, in fact, know these things. Maybe government involvement would force these low cost clinics to be more liable? Maybe not.
3. This could be because I'm still trying to butt my head into the field, but what exactly is meant when the article says vet med is already a highly regulated industry? Last I heard, we were enjoying the spoils of ELDU. And enjoying the work of volunteers/shadows, who can be in the exam room with a doctor without worrying about HIPAA-esque laws. I know there are still confidentiality measures, but not to the same extent.

Edit: I also want to add that whoever wrote this article is clearly trying to sway opinions anyways. You can't compare a soup kitchen or shelter to a low cost clinic. Apples to oranges. You can survive without a pet...you can't survive without food.

 

[KCgophervet]

It bothers me that the article compares low cost clinics to things like soup kitchens and homeless shelters.

There are different problems that some people above have already mentioned, in that if there's no proof-of-income required, there are plenty of people who can afford regular care that will instead opt for the low-cost option. While on some level yes this contributes to a free market economy etc and so on, if they're getting things like tax breaks and are a non-profit status collecting money as a charity, then yes there's a problem. There's no way regular businesses can compete with that fairly. And unlike going to a homeless shelter or a soup kitchen there's no real stigma against people who can afford it using these low-cost options, and the people using it don't see the potential difference in level of care like you would at the other charitable locations (not getting an exam for vaccines may not seem like a big deal to the aforementioned soccer mom, but you can bet she would notice a difference between a bed in a shelter compared to her SleepNumber at home).

Not planning on going into clinical practice, so I really don't have much personal experience or anything, but in reading various articles I can see where the problems can come from. Although they also seem pretty easily fixed by ensuring proof-of-income and then everyone's happy.

 

[deleted480308]

On one hand, I completely understand wanting to get rid of competition that is doing vaccines at rates you just can't match. On the other hand, I can't see it being a good idea to continue with the effort to shut these places down. My two cents:
1. Based off of the sentiments of veterinarians I have worked with, they don't necessarily want to provide services to those who come in and either a. refuse to pay over a certain amount, regardless of income b. honestly cannot afford good care (routine or emergency). While they certainly want to provide that quality care to these animals, they cringe whenever they hear "Oh, and I don't have more than $50 for this" or "Doctor, we're stopping at $100, okay?" This is how veterinary medicine becomes a charity, and how good doctors end up volunteering in their own businesses. If you don't offer freebies, you're a horrible person. These low cost clinics pull those clients with financial troubles or those who just don't want to pay, and the clients who can pay/willing to pay will remain. These clients can't go to a low cost emergency clinic, though, so they'd still have to go to the 'normal' clinic anyways. I can't see it being a HUGE loss, although I can understand when some clinics are pinching pennies that they might feel that loss a bit more.
2. I guess I can see why these places should be more regulated. I've met a few clients who went to Tractor Supply or Petsmart or even just to the local shelter for cheap vaccines, and came to us the next day asking why their dog was covered in hives. "Well, your dog had a vaccine reaction. Why didn't you call the vet that gave the injection?" "They're not there anymore, and they never told me this could happen. I called and they told me to see another vet." I'm not sure if government involvement would solve those particular issues that I've experience such as: Not warning clients about potential reactions, not giving clients proper/good instructions for meds, not emphasizing the importance of keeping your receipt potentially for the life of the dog so you can provide a history in the case of an emergency, etc. You can argue that these clinics don't necessarily serve to educate, but to me, those are basic points that the doctor/tech/assistant/whoever at these low cost clinics needs to cover. Hearing "I don't know what vaccines my dog got, we just took him to the local pet supply store and they did some stuff" occurs far too often. Clients should take charge and know these things, but a lot don't realize that they should, in fact, know these things. Maybe government involvement would force these low cost clinics to be more liable? Maybe not.
3. This could be because I'm still trying to butt my head into the field, but what exactly is meant when the article says vet med is already a highly regulated industry? Last I heard, we were enjoying the spoils of ELDU. And enjoying the work of volunteers/shadows, who can be in the exam room with a doctor without worrying about HIPAA-esque laws. I know there are still confidentiality measures, but not to the same extent.

I understand your point on #1, when my wife asked for a dog we had the "and what's the dollar limit we place on care for the dog if something happens" talk. She loves it, but if you don't have $5k, you don't have $5k. As a side note, she did tell me recently that our agreed limit will change once I make attending. If that thing can avoid health issues until then my wife will make it immortal.

 

[NStarz]

There's also a problem when low cost vaccine/spay/neuter clinics go from low cost vaccine/spay/neuter clinics to full service low cost clinics, offering cystotomies, FB surgeries, COHATs, etc. I think no vets would have problems with these clinics if they means tested and the donations were used to help those animals who really needed it. But when you see your regular clients utilizing those clinics on a regular basis, it makes the 'for-profit' vet look bad and 'money-hungry' because they dare to charge a reasonable fee for their services. That being said, these clinics aren't going anywhere, and vets who choose to go against them aren't going to win any bonus points with the public.

 

[Puffins]

That being said, these clinics aren't going anywhere, and vets who choose to go against them aren't going to win any bonus points with the public.

I agree with this. I think low cost spay and neuter clinics are an inevitability. This article on DVM360 is an interesting read: http://veterinarynews.dvm360.com/profit-spay-neuter-clinics-seek-fill-niche. It explains the perspective of those operating low cost spay and neuter clinics and how they see themselves in their veterinary community.